A pessoa em fim de vida e família : o processo de cuidados face ao sofrimento

Tese de doutoramento, Enfermagem, Universidade de Lisboa, com a participação da Escola Superior de Enfermagem, 2011A doença incurável confronta a pessoa com mudanças radicais que resultam em sofrimento humano. Acompanhar esta fase realça a importância do cuidar humano, destacando-se o papel do enfermeiro com intervenções propiciadoras de uma melhor qualidade de vida e preservação da dignidade da pessoa. Constitui-se objectivo deste estudo: compreender as dinâmicas do processo de cuidados mobilizados pelos enfermeiros face ao sofrimento da pessoa em fim de vida e família num hospital de agudos tendo como finalidade contribuir para o desenvolvimento de estratégias de intervenção favoráveis ao alívio do sofrimento da pessoa em fim de vida e família e para o processo de formação em enfermagem nesta área. Estudo de natureza qualitativa, com recurso a multi-técnicas (observação não participante, entrevistas semi-estruturadas e consulta documental) em unidades de medicina. No estudo participaram enfermeiros, pessoas em fim de vida e família. Os dados foram analisados segundo o referencial teórico e metodológico da grounded theory utilizando-se o paradigma de Strauss e Corbin (2002) e sustentados no interaccionismo simbólico. Os resultados obtidos sugerem que o processo de acções e interacções dos enfermeiros na resposta ao alívio do sofrimento da pessoa em fim de vida e família assentam em dois paradigmas de intervenção que co-existem nas unidades de medicina. Uns enfermeiros desenvolvem intervenções centradas na pessoa privilegiando as várias dimensões do sofrimento humano, outros desenvolvem intervenções centradas na patologia. Contudo, evidencia-se uma evolução progressiva do cuidar biomédico para um cuidar mais próximo do cuidado paliativo. As dinâmicas utilizadas pelos enfermeiros no cuidar a pessoa em fim de vida e família, expressam a atribuição de significados ao sofrimento humano e como estes orientam este processo. Sobressai deste estudo que o sofrimento deve ser considerado um sinal vital, integrando necessária e substancialmente a praxis ajustada numa visão integradora das múltiplas dimensões da pessoa em fim de vida e família.The incurable disease confronts the person with radical changes which result in human suffering, distinguishing the nurse’s role with propitiating interventions of a better quality of life and the preservation of the person’s dignity. The objective of this study: to understand the dynamics of the process of mobilized care by nurses regarding the suffering of the person at life’s end and family in an acute hospital with the objective of contributing to the development of strategies of favorable intervention in the relief of suffering of the person at life’s end and family and for the formation process in nursing in this area. The study of a qualitative nature, resorting to multi – techniques (non-participating observation, semi-structured interviews and documental consultation) in medicine units. Nurses and people at life’s end and families participated in this study. The data was analyzed according to the theorical and methodological referential from the grounded theory using the Strauss and Corbin Paradigm (2002) and based on symbolic interactionism. The results obtained suggest that the process of actions and interactions by nurses in response to the relief of suffering of the person at life’s end and family are set on two paradigms of intervention which co-exist in the medicine units.. Some nurses develop interventions concentrated on the person privileging the various dimensions of human suffering; others develop interventions concentrated on the pathology. However, there is evidence of a progressive evolution from bio-medic care to a care closer to palliative care. The dynamics used by nurses in the care of the person at life’s end and family, express the attribute of meanings to human suffering and how these orientate this process. It is highlighted in this study that suffering should be considered a vital sign, integrating the necessary and substantial praxis adjusted in an integrating vision of the multiple dimensions of the person at life’s end and family

Using User Journey to map emotional oscillations during CoVID-19 social distancing

The CoVid-19 pandemic has demanded society to social distance, which significantly affected not only people's routine but also and their mental health. The way each person is facing this period of confinement is shaped according to their principles, culture, health, and financial stability, thus leading individuals to react emotionally in different ways. Through Design, it is possible to map these experiences and represent them through User Journeys, allowing clear representations of how the experience took place when facing the fear of contagion, the sudden change of routine, and isolation. This study focuses on discussing the effectiveness of unifying different experiences in a single representation, mainly to outline emotional aspects. Trying to balance all emotional variations in a single User Journey prevents the researcher from seeing important details of the users' experience. In this study, the need to use individual User Journeys was evidenced when it is intended to analyse the emotional aspects of users when dealing with products or services, as individuality can shed light on aspects not observable in a consolidated analysis

Avaliação do risco cardiovascular numa população da zona Norte do País

As doenças cardiovasculares lideram as causas de mortalidade no mundo e em Portugal. Alguns dos fatores de risco (FR) associados são sexo masculino, idade avançada, hipertensão arterial, hipercolesteremia, tabagismo, obesidade e sedentarismo, cuja sinergia amplifica o risco cardiovascular. Realizou-se um rastreio em indivíduos da região norte de Portugal, com o objetivo de determinar, pela tabela derivada do projeto SCORE, o Risco Cardiovascular Absoluto e o Risco Cardiovascular Relativo e Risco Cardiovascular Absoluto Projetado aos 60 anos. Verificou-se a presença de vários FR na amostra em estudo. A avaliação do risco permite estimar a interação de FR individuais, fundamentando a definição de estratégias interventivas, com potenciais ganhos em saúde.Cardiovascular diseases are a major cause of mortality in the world and Portugal. Most common associated risk factors (RF) are male gender, advanced age, hypertension, hypercholesterolemia, smoking, obesity and sedentary habits, whose interaction increases the cardiovascular risk. We conducted a screening in individuals from Northern Portugal, in order to determine the Absolute and Relative Cardiovascular Risks and 60 years old Risk Projection through the table derived from the SCORE project. We observed the presence of various FR in the sample. The cardiovascular risk assessment allows estimating the interaction of individual RF, enabling the definition of an intervention, with potential gains in health

Angiotensin-converting enzyme-inhibitory activity of extracts of hydrolysed k-casein glycomacropeptide: stability under simulated gastrointestinal digestion

Dietary proteins usually possess a wide range of nutritional, functional and biological properties; many of such biological properties have been attributed to physiologically active peptides, which are encrypted within the protein sequence. k‐Casein glycomacropeptide (CMP) – one of the main components of whey, is released in the first step of (enzymatic) cheese making – and has been claimed to act as mediator in important biological pathways. Peptides released from CMP via enzymatic or microbial activity have indeed been proven to posses inhibitory activity against the angiotensin‐converting enzyme (ACE). However, they will not act properly in the human body unless they can resist gastrointestinal digestion, as well as be absorbed and reach the cardiovascular system in active form. On the other hand, several studies have already demonstrated the important role of gastrointestinal digestion upon ACE‐inhibitory peptide formation. Therefore, the aim of this study was to evaluate the ACE‐inhibitory activity of peptide extracts obtained via hydrolysis of CMP, using an extract of Cynara cardunculus as enzymatic vector. Moreover, such peptides were subjected to simulated gastrointestinal digestion, in order to assess their stability and the evolution of their ACE‐inhibitory activity. A 40 g/L solution of CMP, hydrolysed with 8.5 %(w/w) commercial crude extract of C. cardunculus, exhibitedACE‐inhibitory activity corresponding to IC50 values of 296.0 mg/mL (total fraction), 63.0 mg/mL (3000 Da fraction). The identification of peptides proceeded by LC‐MS, and permitted identification of the following peptides: MAIPPKKNDQD (k‐CN f106‐115), as potentially responsible for antihypertensive activity; and TVQVTSTAV (k‐CN f161‐169) and MAIPPKKNDQD (k‐CN f106‐115), as potentially responsible for antithrombotic activity, because both encompass sequences analogous to the bioactive fragment f400‐411 of fibrinogen g‐chain. A new peptide, KTEIPIN (k‐CN f116‐123), was also identified to relatively high concentrations, with a promising antihypertensive activity. Studies concerning the in vitro simulation of gastrointestinal digestion were conducted; the gastrointestinal stability of the total extract and of the 3000 Da peptide fraction, as well as of the plain CMP (used as control), following incorporation in water and fruit juice, was tested in said gastrointestinal model, but none of said fractions was significantly affected.info:eu-repo/semantics/publishedVersio

Grape stalk valorization for fermentation purposes

White and red grape stalks biomass were fractioned to maximize its economic value by the production of fermentable sugars, as other value streams. High yields of extractives and lignin were first obtained, originating a biomass rich in cellulose and hemicellulose, which was subject to acid and enzymatic hydrolysis for production of fermentable sugars. Higher concentrations of sugars were obtained by enzymatic than by dilute acid hydrolysis. These biosugars were used for fermentation processes with Pichia stipitis and Saccharomyces cerevisiae. The presence of higher quantities of xylose favoured P. stipitis to produce higher ethanol yields than S. cerevisiae which is glucose lover. Cellulose nanocrystals were produced from the resulting biomass without monosaccharides. For the first time an integrated valorization of grape stalks followed by an application of one of the valorized streams is presented.info:eu-repo/semantics/publishedVersio

Percepções de mulheres da região Sul de Santa Catarina sobre o papel da doula

Trabalho de Conclusão de Curso, apresentado para obtenção do grau de Psicólogo no curso de Psicologia da Universidade do Extremo Sul Catarinense - UNESC.Prestar assistência à mulher gestante, parturiente e puérpera, caracteriza-se como função pertencente ao trabalho da doula. O objetivo desse estudo consistiu em compreender quais as percepções de mulheres sobre o papel da doula, durante sua gestação, parto e puerpério. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da Universidade do Extremo Sul Catarinense – UNESC, por meio do CAAE 15969119.8.0000.0119. Participaram desse estudo seis mulheres, com faixa etária entre 21 e 40 anos. Realizou-se a pesquisa por meio de uma entrevista semiestruturada. O discurso das participantes foi analisado em cinco categorias de análise, denominadas: Motivos pelos quais a doula é contratada; Colaborações da doula no período gravídico-puerperal; Período mais significativo do acompanhamento; Potencialidades e dificuldades do acompanhamento; e Indicação do trabalho da doula. Concluiu-se que, na percepção das mulheres, o acompanhamento da doula demonstrou-se satisfatório, tornando a experiência da gestação, parto e puerpério amplamente natural e/ou humanizada, saudável e positiva

Screening of pathogenic variants of the DMD gene in female patients with undetermined muscular dystrophy

Dystrophinopathy (Duchenne/Becker muscular dystrophy, DMD/BMD), a progressive neuromuscular disease with an X-linked recessive inheritance, is caused by pathogenic variants in the DMD gene, including large deletions (68%), duplications (11%), point variants (20%) and others. Although the majority of females heterozygous for these variants are asymptomatic, about 2.5-7.8% may have some symptom manifestations.info:eu-repo/semantics/publishedVersio

Potential prebiotic effect of whey protein and spent brewer yeast hydrolysates by enzymes of Cynara cardunculus extract

Biologically active peptides are of particular interest to food science and health since they have demonstrated beneficial physiological roles upon ingestion. These biopeptides can be released and/or activated in vivo during gastrointestinal digestion or otherwise via enzyme-mediated proteolysis throughout food processing. The survival of many bacterial species inhabiting the large bowel depends essentially on the substrates made available to them, most of which come directly from the diet. Some of these substrates can be selectively considered asprebiotics - which are nondigestible food ingredients that can stimulate beneficial bacteria such as lactobacilli or bifidobacteria growth in the colon. Thus, the major objective of this research work was to study the potential prebiotic activity of peptide extracts obtained via hydrolysis of whey proteins from a mixture of milk (cow, ewe and goat) and spent brewer yeast extracts achieved by cardosins present in Cynara cardunculus aqueous extract. The strains tested were probiotic strains viz. Lactobacillus acidophillus Ki and Bifidobacterium lactisBb12 and Frutooligosacharides were used as positive control of prebiotic activity. From whey protein hydrolysates two fractions were tested, the ultrafitration permeate (PM >1000 Da and 20000 Da). Incorporation of the extracts in media without glucose did not produce such good results, but the better activity was obtained for the ultrafiltration permeate of whey hydrolyzate (>1000 and >20000 Da); this result was expected since both extracts stimulate mainly the bacterial growth through the nitrogen compounds: peptides and aminoacids.info:eu-repo/semantics/publishedVersio

A CRIAÇÃO DE CONFIANÇA ATRAVÉS DE INTERFACES DIGITAIS

O exponencial avanço das plataformas digitais focadas em conectar e intermediar a oferta e a demanda gera necessidades de criar produtos digitais capazes de fomentar a confiança entre indivíduos desconhecidos. Para isto, as plataformas estão recorrendo a recursos de interface que possam auxiliar neste processo. Este artigo tem o objetivo avaliar como as plataformas digitais estão gerenciando as interações e estimulando a confiança entre compradores e vendedores. Para isto, foram analisados os recursos utilizados pelo Mercado Livre e pelo Olx em suas páginas de apresentação da oferta, e como estes recursos estão distribuídos e focados em auxiliar a tomada de decisão do comprador. Ao final, é possível notar as diretrizes claras adotadas em cada uma destas plataformas, e como as decisões de negócio e diferentes modelos de monetização estão diretamente conectadas com os recursos disponíveis na interface